PUYALLUP TRIBAL HEALTH AUTHORITY, located in Tacoma, Washington is seeking a Claims Specialist.
“It is the mission of the Puyallup Tribal Health Authority to provide quality healthcare and promote wellness in a culturally appropriate manner.”
We offer an outstanding workplace, competitive market based salary, and benefits packages including:
- Monday – Friday schedule
- Medical/Dental/Vision benefits – monthly premiums paid 100% for employees
- 18+ annual paid holidays
- Generous paid sick and vacation accruals
- 401(k) with annual profit sharing
- Life & AD&D insurance coverage
- PTHA is an approved loan repayment site for various programs
- Employee Assistance Program
- Excellent work/home life balance
GENERAL FUNCTION: Provide assistance to PTHA patients in gaining access to health care services and eligibility for Referral Services coverage. Process receipts and disbursements for contracted services.
- Ensures that all IHS and Supplemental eligibility requirements are met prior to releasing claims for payment with 100% accuracy. Interpret alternate resource requirements and explain to health care providers and patients.
- Explain various programs, policies and procedures to patients such as and not limited to: Supplemental policy, contract care policy, referral policy, exclusion lists and other various organizational policies.
- Works closely with the referral services and Patient Access Team in collaboration to ensure the proper policies and procedures are followed.
- Ensures that all alternate resources have been exhausted for client before payment is authorized with 100% accuracy.
- Assist other Patient Accounts staff with claims as needed to minimize backlog.
- Review, document, adjudicate and process claims pursuant to established policy and procedures, with 100% accuracy.
- Research unpaid bills received from patients and providers. Review no Check List received from Third Party Administrator monthly.
- Review, process, research and document pended claims for eligibility, authorization of third party coverage and payment/denial determination, with 100% accuracy.
- High School Diploma or GED.
- Two (2) years’ administrative/customer service experience in a health care setting.
- Experience and/or ability to work with an Electronic Health System.
- Must have good computer skills and proficiency in MS Office products (Word, Excel, Outlook, etc.).
- Application and utilization knowledge of: private insurance plans, state Medicaid programs and Medicare.
- Demonstrable knowledge of claims processing to include coordination of benefits, understanding of CPT and ICD-10 coding, medical and dental terminology.